What is lipedema?
Lipedema is a disorder that causes an abnormal buildup of fat cells in the legs, thighs, and buttocks. It typically affects women and is often misdiagnosed as obesity or lymphedema. The exact cause of lipedema is unknown, but it is thought to involve genetic, hormonal, and inflammatory factors. Some quick facts about lipedema:
– Primarily affects women, especially during puberty, pregnancy, and menopause. Rarely affects men.
– Causes symmetrical and disproportionate fat accumulation in the legs, thighs, and buttocks. Arms are often unaffected.
– Leads to a column-like shape in the lower body with thick ankles and wrists.
– Pain, tenderness, and easy bruising are common symptoms.
– Weight gain in the lower body is out of proportion with diet and exercise.
– Fluid retention and swelling may occur in the limbs.
– Lipedema fat is resistant to diet and exercise – it does not respond like regular body fat.
What are the stages of lipedema?
Lipedema typically progresses through 3 stages:
Stage 1: The skin has a smooth appearance and feels soft. Fatty tissue is evenly distributed, giving the limbs a column shape. Minor swelling and tenderness may be present.
Stage 2: The skin develops a nodular texture from small fatty deposits. Fat builds up unevenly causing irregular contours. Swelling is more noticeable and pain/tenderness increases.
Stage 3: Large amounts of hardened fat deposits develop, leading to major swelling in the limbs. The tissue becomes very painful to the touch and easy bruising occurs. Mobility may be impaired at this advanced stage.
What causes lipedema fat to accumulate?
The exact mechanisms that cause lipedema fat accumulation are not fully understood. However, research suggests that several factors contribute to the dysfunctional storage and growth of fat cells:
– Genetic mutations – variants in genes involved in fat cell development and inflammation may promote lipedema.
– Hormonal influences – estrogen and progesterone sensitivity are thought to play a role. The condition worsens during puberty, pregnancy, and menopause.
– Lymphatic system dysfunction – impaired drainage of fluid and waste products from the tissues can cause swelling.
– Inflammation – proteins that promote inflammation are elevated in lipedema fat. Inflammation stimulates growth of new blood vessels.
– Enlarged fat cells – increased stress on connective tissue may cause fat cells to expand, proliferate, and trigger inflammation.
Why is lipedema often misdiagnosed?
There are several reasons why lipedema is underdiagnosed or mistaken for other conditions like obesity and lymphedema:
– Lack of awareness – Many doctors receive little training on lipedema in medical school. Patients are unaware it is a medical condition.
– Overlap with obesity – Lipedema often coexists with excess weight. Doctors focus only on obesity and fail to recognize lipedema.
– Non-specific symptoms – Leg pain, swelling, and easy bruising have many potential causes. Lipedema may not be considered.
– Normal laboratory tests – There are no blood tests or imaging to definitively diagnose lipedema. Biopsies are sometimes done.
– Stigma of obesity – Patients feel blamed for having a “fat disorder” and avoid seeking care. Doctors share these weight biases.
– Lipedema is not officially recognized – It does not have a dedicated diagnostic code. It falls under “lipodystrophy” disorders.
– Lipedema is understudied – Little research exists on the pathophysiology and optimal treatments. More medical education is needed.
What natural remedies may help lipedema?
There is no cure for lipedema, but certain home remedies and lifestyle changes may help manage symptoms:
– Weight management – Losing excess body fat reduces stress on the limbs. However, the lipedema fat will remain.
– Lymphatic drainage massage – Specialized massage techniques help drain fluid buildup and can temporarily reduce limb size.
– Compression garments – Wearing medical-grade compression stockings and sleeves improves circulation and minimizes swelling.
– Low-impact exercise – Gentle activities like walking, swimming, or cycling help avoid injury to tender fat tissue.
– Pain management – Over-the-counter medications, heating pads, and topical creams may relieve aches and pains.
– Balanced diet – Eating anti-inflammatory foods high in antioxidants and omega-3s promotes healing.
– Stress reduction – Relaxation techniques like yoga and meditation help ease emotional burdens.
– Dry brushing – Using a brush on dry skin may stimulate circulation and lymph drainage. More research is needed.
Can massage therapy be beneficial?
Yes, massage therapy is commonly used to aid lipedema management. Manual lymphatic drainage (MLD) is a specialized light-pressure massage technique that can:
– Stimulate lymph vessels to improve drainage of fluid, proteins, and waste. This reduces limb size and swelling.
– Loosen adhesions between the skin and underlying tissue to diminish pain and hardness of fat.
– Increase blood flow to nourish cells and return fluids to the lymph system.
– Relax muscles and soften fibrotic tissue caused by chronic inflammation.
– Decrease bruising by strengthening fragile blood vessels.
– Provide psychological benefits by reducing stress and anxiety.
Clinical studies show MLD massage significantly reduces limb circumference in lipedema patients immediately after treatment. Combining MLD with compression garments provides longer-lasting effects between massage sessions.
However, massage alone cannot eliminate lipedema fat or cure the condition. It must be used alongside other therapies like weight control, exercise, and psychological support. Consistency is also key – getting monthly MLD massages or doing self-massage at home provides the best results.
What MLD massage techniques are used?
Lymphatic drainage massage for lipedema uses very light pressure and various hand movements to stimulate lymph flow:
– Stretching – Gently pulls and stretches the skin to mobilize fluid in tissues.
– Fanning – Brushing fingertips across the skin in fan-like motions. Helps propel fluid through lymphatic vessels.
– Pumping – A rapid push-release motion using the palm to pump the lymph. Drainage follows the path of lymph nodes.
– Circular rubbing – Small circles with the fingers or knuckles help coax fluid toward lymph nodes.
– Skin rolling – Grasping and gently rolling the skin between the fingers and thumbs. Mobilizes fluid in connective tissue.
– Clearing – Large flat hand shapes guide excess fluid from congested areas to healthier drainage regions.
MLD massage always follows the direction of lymph flow toward lymph nodes. It starts distally at fingers/toes and works proximally up the limbs. Entire treatment takes 30-60 minutes and is done 1-5 times weekly.
Are there risks or contraindications for lipedema massage?
While generally safe when done correctly, MLD massage has some risks and conditions where it should be avoided:
– Injury risk if excessive pressure is applied to fragile fat tissue. Gentle touch must be used.
– Can temporarily increase limb size after treatment as fluid shifts occur. This normally improves quickly.
– Not recommended for active infections, inflammatory conditions, deep vein thrombosis, or immediately after surgery.
– Use carefully in patients with congestive heart failure, kidney disease, blood clots, or cancer as fluid shifts affect these conditions.
– Pregnant women may only receive very light massage by specially trained therapists. Deeper MLD is contraindicated.
– Broken skin, wounds, or irritation may become aggravated. The area must be avoided.
– Certain medications like blood thinners, diabetes drugs, diuretics, and hormonal treatments can influence effects.
To minimize risks, massage therapists must receive proper MLD training and experience treating lipedema patients. Clients should also consult doctors to address any underlying medical conditions or contraindications before starting massage. When performed correctly, MLD has an excellent safety profile.
What are other advanced massage techniques for lipedema?
In addition to traditional MLD, some massage therapists incorporate other modalities into lipedema treatment:
– Myofascial release – Applying gentle sustained pressure to fascia and connective tissue helps release myofascial adhesions and fibrosis. This reduces pain and texture abnormalities in lipedema skin.
– Vacuum-assisted massage – A handheld device with suction is used to grip, pull, and mobilize tissue. May enhance fluid and waste removal. More research is needed.
– Cupping therapy – Silicone or glass cups create suction on the skin to lift connective tissue and improve blood and lymph flow. Helps drain fluid and reduce swelling.
– Instrument-assisted soft tissue mobilization (IASTM) – Tools like rigid plastic scrapers are stroked over the skin to break down fascial restrictions and scar tissue, relax muscles, and increase mobility.
– Trigger point therapy – Ischemic compression or injections into trigger points (tight muscle knots) can relieve myofascial pain. Commonly needed for lipedema.
– Vibration therapy – Mechanical vibration plates or handheld wands help stimulate fluid movement and relax muscles when used carefully.
However, these modalities require specialized training and careful application to avoid injury in lipedema tissue. Enough research does not yet exist on their efficacy and safety.
What results can be expected from massage?
It is important to have realistic expectations about the benefits of massage for lipedema:
– Temporary reduction of limb size, swelling, and bruising is commonly seen. Effects diminish over 1-3 days as fluid reaccumulates.
– Pain relief occurs in many patients, especially from techniques like myofascial release. But pain returns and massage must be ongoing.
– The characteristic nodular, disproportionate fat of lipedema cannot be permanently reduced through massage alone. It is not a cure.
– Effects are localized – only massaged body regions improve. Other areas are unaffected.
– Results require multiple (often 10+) consistent massage sessions over months. Irregular therapy does not provide lasting effects.
– Benefits depend heavily on the skill level of the massage therapist and techniques used. Results vary.
– Psychological stress reduction occurs for many patients from the relaxation response and caring touch.
– When combined with compression garments and other treatments, massage can be a helpful part of managing lipedema. But it has limits.
Are there specialists who treat lipedema with massage?
Yes, there are massage therapists who specialize in treating lipedema patients:
– Certified lymphedema therapists (CLTs) – Have advanced training in MLD massage and lipedema-specific protocols. CLT is an official credential overseen by LANA – the Lymphology Association of North America.
– Certified lipedema practitioners – A certification program focused on lipedema massage, compression, and care is offered by the Lipedema Treatment Center. Graduates become CLPs.
– Doctors of lymphatic medicine (DLMs) – These physicians are trained in lymphedema and lipedema treatments including prescription massage protocols.
– Massage therapists with lipedema experience – Those who have worked extensively with lipedema clients may offer excellent therapy even without special certification.
– Self-lymphatic drainage (SLD) – Lipedema patients can learn to safely perform simple MLD techniques on themselves at home for maintenance between therapist massages.
It is important to choose a massage therapist who understands the unique needs of lipedema clients. Having specialized training, credentials, and years of experience treating lipedema patients is ideal.
Is massage therapy covered by insurance for lipedema?
Unfortunately massage therapy is not directly covered for lipedema in most cases. However, patients may be able to get some massage costs reimbursed in certain situations:
– If diagnosed with secondary lymphedema (in addition to lipedema) and massage is prescribed by a doctor, insurance may provide some coverage. But limits often apply.
– Flexible spending accounts (FSAs), health savings accounts (HSAs), or reimbursement assistance programs offered through work may help offset costs.
– Massage schools or therapists sometimes offer discounted lipedema massage prices for this population.
– Massage therapy and compression supplies prescribed under medical supervision can be paid with a health reimbursement arrangement (HRA).
– Network with lipedema support groups to find massage therapists willing to offer free or discounted services to those in financial need.
Due to insurance barriers, many lipedema patients must pay high out-of-pocket costs for massage therapy. It is important to advocate for updated insurance policies that recognize massage as a standard medical treatment for lipedema. More research on massage benefits for lipedema will also help increase coverage.
Conclusion
In summary, massage techniques like manual lymphatic drainage can provide tangible benefits for people with lipedema, a poorly understood fat disorder. MLD performed by trained lymphatic therapists may help reduce swelling, pain, and bruising in the limbs when done consistently. It is an important part of a comprehensive treatment plan alongside weight control, compression garments, exercise, and psychological support.
But massage alone cannot cure or eliminate lipedema, and insurance coverage remains very limited. More medical education, research, and updated policies are critically needed so people with lipedema can access and afford massage and other essential therapies. When combining massage with self-care and medical treatments, patients see the best long-term management of their lipedema symptoms.